Intercultural dynamics producing possible misunderstanding:
- Recitation of possible negative outcomes in some cases is believed to “call forth” negative outcome.
- Explanation of possible negative outcome produces loss of hope.
- Family expectations that elders should be protected from bad news.
- Family/patient answering “yes” to questions in order to show respect or not to appear foolish.
- Cultural family hierarchical patterns in which a family member other than the patient is expected to be the decision maker.
Techniques to minimize confusion and misunderstanding:
- Use cultural guides to determine acceptability of talking to older patients directly.
- Ask older patients if there is a preferred spokesperson.
- Ask patients if they would like to consult with, or appoint someone else as decision maker.
- Ask patients to explain in their own words what they understand about the procedure.